DOCUMENT RESUME
ED 398 685 EC 304 977
AUTHOR Johnson, Lara; And Others
TITLE The Missing Link: Self Study Continuing Education for Nutrition Services Awareness in Early Intervention.
Workbook.
INSTITUTION New England Medical Center, Boston, MA.
SPONS AGENCY Health Resources and Services Administration
(DHHS/PHS), Washington, DC. Maternal and Child Health Bureau.
PUB DATE 95
CONTRACT MCJ-259328
NOTE 35p.; Accompanying videotape not available from EDRS.
Cover title: The Missing Link: Including Nutrition Services in Early Intervention Programs. A Trainer's Manual. A product of the Frances Stern Nutrition Center and Shriver Center University Affiliated
Program.
AVAILABLE FROM Frances Stern Nutrition Center, New England Medical Center #783, 750 Washington Street, Boston, MA
02111.
PUB TYPE Guides Non-Classroom Use (055) EDRS PRICE MF01/PCO2 Plus Postage.
DESCRIPTORS Child Health; Delivery Systems; Early Childhood Education; *Early Intervention; Federal Legislation; Individualized Family Service Plans; Infants; Models; *Nutrition; *Nutrition Instruction; Physical Health; Program Evaluation; *Special Health Problems; Young
Children
IDENTIFIERS Individuals with Disabilities Education Act Part H
ABSTRACT
This workbook is a companion to an 18-minute instructional video on nutrition services in early intervention programs. Both the workbook and the video are designed to assist early intervention professionals concerning nutrition and feeding concerns of children with special health care needs. The following issues are addressed: importance of nutrition services; the range of common nutrition problems faced by early intervention clients and their families; the effects on families when nutrition issues are not addressed; an appropriate model for providing screening and
intervention nutrition programs; obtaining services of a qualified nutritionist and effective integration into the early intervention
care process; and how nutritionists function to meet the
nutrition-related needs of early intervention clients. The workbook contains a pre-assessment and post-assessment checklist, video
trigger questions and answers, issues for discussion, information on the background of the problem (including federal regulations and status of nutrition services in early intervention programs), sample
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U.S. DEPARTMENT OF EDUCATION
Office of Educational Research andImprovement E.C., E DUC
IONALCREENSTOUR(ECREISINFORMATION CENTER (ERIC)
This document has been reproduced as received from the person or organization originating it.
Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this document do not necessarilyrepresent official OERI position or policy.
THE
MISSING
LINK
Including Nutrition Services in
Early Intervention Programs
THE MISSING LINK
Self Study Continuing Education for
Nutrition Services Awaren'ess in Early Intervention
Workbook
by
Lara Johnson, M.S., R.D.
Carole Palmer, Ed.D., R.D.
Dena Goldberg, Ph.D., R.D.
Mallai Holland, MPH, RD, CD
Johanna T. Dwyer, D.Sc., R.D.
Andrea Morris, B.S.
Frances Stern Nutrition Center
New England Medical Center
and
Shriver Center University Affiliated Program
Funded by Grant #MCJ 259328 Maternal and Child Health Bureau
Health Resources and Services Administration
Welcome to The Missing Link
A video and workbook program designed to help identify and
meet the nutritional needs of Early Intervention clients.
WORKBOOK CONTENTS: Page #
How to use this program 3-4
Program Objectives
Instructions for Group Leader
Pre Assessment 5
Taken before studying the workbook and watching the video.
Video Trigger Questions 6
These questions helps viewers focus on the specific issues raised by the families and health professionals in the videotape.
Issues for Discussion 7-8
These questions will assist in facilitating a more in-depth discussion of the issues raised in the videotape and related issues.
Background of the Problem 9-10
What are the Regulations?
Why are Nutrition Services Essential?
What is the current status of Nutrition Services in Early Intervention Programs?
0 KBOOK CONTENTS:
Page #
Managing Nutrition Issues
11-16Components of a Comprehensive Nutrition Care Program
Screening for Nutrition Problems
Where to find a Qualified Nutritionist
The Role of the Nutritionis
Financing Nutrition Services
Answers
to the Video Trigger Questions 17-19Post Assessment 20
Taken after studying the video and workbook to determine whether objectives
have been achieved.
Sample Screening Forms 21-26
This Missing Link videotape and workbook is designed to help Early Intervention professionals appreciate the importance of nutrition and feeding concerns in children with special health care needs. It shows how to screen for nutrition issues, and ensure
proper nutrition services for children and families enrolled in Birth to Three Early Intervention Programs (El).
Program Objectives: Through the use of this videotape and trainer's guide, Early Intervention team members will be able to:
Explain why nutrition services are an important component of El programs. Outline the range of common nutrition problems faced by Early Intervention clients and their families.
Describe the affects on families when nutrition issues are not addressed.
Outline an appropriate model for providing screening and intervention of nutrition problems.
Describe how the services of a qualified nutritionist can be attained and integrated effectively into the Early Intervention care process.
Discuss, in general, how nutritionists function to meet the nutrition-related needs of El clients.
The Video: In the Missing Link videotape (20 minutes), three families who
received Early Intervention Services describe the nutrition concerns they faced,
the ways in which nutrition issues disrupted family life and functioning, the types of nutrition assistance they received and the difference that nutrition services made in their lives. Nutritionists and other health professionals who worked with these families discuss the nutrition-related problems and the barriers they faced in attempting to meet the nutrition needs of El families.
The Workbook: The workbook is designed to provide guidance for analysis and discussion of the videotape, as well as background information and important
resources.
Instructons for Group Leaders:
Step 1: Have participants complete the pre-assessment on page 5 prior to watching
the videotape.
Step 2: Show the videotape.
Step 3: Use the trigger questions on page 6 to discuss issues raised in the video (see pages 17-19 for answers to video trigger guestions).
THE MISSING LINK
Pre Assessment
Strongly Agree Agree Undecided Disagree Strongly DisagreeNutrition is extremely important to the health and well being of Early Intervention clients and their families. Nutrition services are an important component of Early Intervention programs. The number of nutrition problems faced by Early Intervention children and their families are few/minimal. Our initial intake survey is sufficient to pick up nutritional issues and problems. I have a good idea of the types of nutrition problems faced by El families. I have a good idea of what types of nutrition interventions are needed to resolve common nutrition problems of Early Intervention children. I have a good idea of how Early Intervention teams can realistically include nutrition services into the team management of Early Intervention children and their families. I think that our own Early Intervention team can improve the nutrition services provided to Early Intervention clients and their families.
8
The Gonzales Family
1. What was Mrs. Gonzales' major nutrition concern about her daughter Jennifer? 2. How did Mrs. Gonzales attain the services of a nutritionist?
3. What did the nutritionist do at the home in terms of screening and assistance? 4. How did the nutritionist help with the feeding problems?
The Whittle Family
1. How did Jeanine Whittle feel when Jeffrey starting losing weight?
2. Why did feeding issues become such a primary concern for the Whittle family? 3. How did the nutritionist help the Whittle family?
4. What benefit did the Whittle family receive from nutrition services?
The Mitchell Family
1. How long did it take Mrs. Mitchell's service coordinator from the Early Intervention Program to recognize her child's nutrition and feeding concerns?
2. What helped the Early Intervention case manager identify the need for nutrition services?
3. What were the reasons for having the nutritionist become involved? 4. How did the nutritionist complete a nutrition assessment?
5. What kind of recommendations did the nutritionist provide?
6. How did the transition to table foods help the Mitchell twin's development? 7. How could nutrition issues have been identified earlier?
8. What benefit did the Mitchell family receive from nutrition services?
7
The "Missing Link" videotape highlights three major issues:
1. The impact nutrition concerns can have on child and family well-being. 2. The benefit of nutrition services to child and family.
3. How nutrition services can be accessed and integrated into the IFSP.
Impact of nutrition concerns:
What impact did nutrition issues have on the families in the video?
Why did nutrition concerns become so significant for the families in the video? 4 Think of a child and family you have worked with that has struggled with nutrition
issues:
How have feeding difficulties impacted them?
How did the presence of nutrition issues impact the achievement of early intervention objectives?
What guidance has been provided to these families in resolving the
problem?
Are there some children and families you work with who could benefit from nutrition services?
Benefit of nutrition services:
4 Why are nutrition services crucial to the efficacy of El programs?
4 What individualized assistance did the nutritionist provide to the families?
4 What is the impact on child and family when nutritional issues are not addressed
and resolved?
4 How would the nutritionist work with the following professionals to ensure integrated, coordinated care?
Nurse o Early Childhood Education
Occupational Therapist e Social Worker
Accessing nutrition Services:
4 How was the need for nutrition services identified? 4 How could the referral system be improved?
4 Does your program have a formal system for identifying nutrition concerns and referring families to nutrition service if needed?
4 How well does this system function? How could it be improved?
BACKGROUND OF THE PR
What are the Regulations?
Part H of PL 101-476 Individuals with Disabilities Education Act (IDEA) mandates that nutrition services be included in the Individualized Family Service Plan (IFSP) if "appropriate" for the child and family . Nutrition services should include both
assessment and management strategies. Assessments should include: (a) nutritional history and dietary intake, b) anthropometric, biochemical, and clinical measures,
(c) feeding skills and feeding problems, and (d) food habits and food preferences. Once nutritional problems have been recognized, appropriate plans to address the nutritional
needs of eligible children should be developed and monitored. Nutritionists are
specifically listed in the legislation to provide nutrition servicesto chidren in
early intervention programs who are in need of such a service.
Why Are Nutrition Services Essential?
Evidence of the benefits of nutrition intervention to the health and development of children with special health needs continues to grow. Improved growth and other nutrition markers have been extensively documented in children who have received needed nutrition services. The evidence ranges from metabolic disorders in which nutrition problems are primary, to conditions in which the nutrition problems or risks
result from secondary biological, environmental, or psychosocial factors.
Nutrition interventions are often related to feeding, and include mechanical and behavioral aspects of food intake. For some children, improved nutrition is the factor most critical for survival; for others it can reduce the potentially debilitating effects of their conditions. Improved nutrition and feeding may increase the level of
independence the child is able to achieve, improve the child's perception of self, and improve care providers' perception of their ability to meet the child's needs. Working in partnerships with families to integrate nutrition services into a coordinated system with other El services, mutual reinforcement and support can be achieved across
disciplines, and services to children and their families can be strengthened.
What is the Current Status of Nutrition Services in EarOy Intervention Prograrns?
Unfortunately, most states currently do not have systems in place for integrating nutrition services into their El programs. Barriers to implementing nutrition services include lack of knowledge regarding the importance of nutrition for this population, lack of knowledge of appropriate roles for nutritionists on El teams, limited access toqualified nutrition providers, and lack of economic resources to pay for nutrition
Components of a Comprehensive Nutrition Care Program:
Identification of children who have risk factors which place them at increased nutritional risk. (Table 1 lists common nutritional problems seen in children with special health care needs.)
Referral of at risk infants and toddlers to a qualified nutritionist for acomplete
nutritional assessment and development of a nutrition care plan.
Inclusion of nutrition concerns and services to be provided in the child's
IFSP.
Interventions for nutritional problems.
Follow up care and continual monitoring of progress and nutritional status.
Table 1
Common Nutrition Problems Seen In Children with Special Health Care Needs
Condition Altered* Growth Rate Altered** Energy or Nutrient Needs Constipation or Diarrhea Feeding Problems Drug Nutrient Reactions Cerebral Palsy 4 4 4 4 Epilepsy/ Seizure Disorder 4 4 4 4 Muscular Dystrophy 4 4 4 4 Myelomeningocele (Spina Bifida) 4 4 4 4 4 Down's Syndrome 4 4 4 4 4 Prader-Willi syndrome 4 4 Al
Metabolic Disorder (PKU,
MSUD)
4 4
Congenital Heart Disease 4 4 4 4
Cleft Lip/Palate 4 4
Autism 4 4 -4
Fetal Alcohol Syndrome 4 4
Other Mental Retardation 4 4 4 4 4
* altered can be inadequate or excessive ** altered can be increased or decreased
Screening for Nutrition Problems:
An effective screening procedure is a critical element in any nutrition program.
Screening is the process by which infants and toddlers at risk for nutrition problems are identified and referred for further evaluation and a care plan is developed with the family. Nutrition screening should be done at regular intervals since growth and development is dynamic and nutritional status can change over time. Effective screening starts with identifying who will be responsible for this task and which tool they will use. Ideally, the same team member would be responsible for the nutrition screening and referral process.
A nutrition screening tool should be:
quick to complete
provide reproducible results
accurately identify children at nutritional risk. include criteria for referral for nutrition assessment inexpensive
Data collected for nutrition screening will depend on the time and personnel available and access to information such as the results of blood tests.
Components of a nutrition screening include:
caregiver concerns medical problems chronic medication use
growth
eating habits
feeding skills and behaviors
Where to Find a Qualified Nutritionist:
Nutrition services should be provided by a Registered Dietitian who has experience with pediatric nutrition and children with special health care needs. Registration requires completion of a bachelors degree with course work meeting American Dietetic Association guidelines, 900 hours of clinical training, and passing the national
registration exam. Maintaining registration requires 75 hours of continuing education every 5 years. Additional desirable professional credentials include a masters degree in public health/nutrition and/or Certified Specialist in pediatrics with the American Dietetic Association.
A qualified nutritionists may include:
State and local public health nutritionists
LEND: Leadership, Education in Neurodevelopmental-related Disorders Nutritionists (formerly called University Affiliated Programs or (UAPs)
Nutritionists at Pediatric hospitals
Nutritionists at specialty clinics for children with special needs
Private practice nutritionists with expertise in pediatrics (Contact American Dietetic Association (1-800-877-1600)
Community health center nutritionists Nutritionists in HMOs or group practices
Ideally the nutrition service provider should possess knowledge of early childhood development, preschool nutrition education, federal, state and community food assistance programs, and community nutrition issues. Specific competencies for registered dietitians working in El are summarized in Table 2.
Table 2
Recommended Qualifications for Nutrition Providers in Early Intervention Programs
Registered dietitian status maintained, licensed in state (if applicable)
Experience in pediatrics with emphasis on children with special health care needs Ability to integrate nutrition assessment and care plan into the IFSP
Ability to make recommendations within a family-centered, culturally appropriate
context
Strong interpersonal and counseling skills for interactions with families and other staff
Effective verbal and written communication skills
Knowledge and skill in process and outcome evaluation (quality assurance, cost-benefit, cost-effectiveness)
The Role of the Nutritionist
The most appropriate staffing option for the nutritionist in an El program varies with the
size of the program, program goals and philosophy, scope and depth of nutritional problems, and availability of qualified providers in the area.
Key Areas of Responsibility of the Nutritionist May Include:
Participation in the IFSP Process
conduct nutrition assessments develop nutrition care plans
monitor child's nutritional status and re-evaluate care plan as needed initiate contacts with other food and nutrition programs to facilitate collaboration among nutrition services needed by child
provide direct nutrition counseling services as requested by families in IFSP (use of home site, phone contacts as appropriate)
Provide Education, Training, and Support Services for Parents And Staff identify nutrition training needs
conduct parent support groups on feeding
develop nutrition education materials for families
conduct staff inservice on growth, nutrition, and feeding
Develope Referral and Follow-Up Community Nutrition Services
identify and establish communication with community and other nutrition service providers
refer clients to community nutrition resources and providers
provide education and training on nutritional needs of children with special needs to staff, parents and community service providers
(SOURCE: Resource 2)
Financing Nutrition Services
A major challenge to implementing nutrition services in all health care settings today is finding adequate methods of reimbursement. Part H of PL 102-119 specifies that services in Early Intervention programs must be provided at not direct cost to families, unless a sliding scale fee system is authorized for certain services, Third party
reimbursement for nutrition services varies among the different insurance companies and between different policies. Reimbursement generally depends upon a physician's referral, and programs would need to establish a fee for service schedule in order to obtain reimbursement. The Early Periodic Screening and Diagnostic Test (EPSDT)
Healthy Kids Expanded Medicaid Program covers some nutrition counseling for
children at high risk . Other possible sources of funds include federal Maternal and
Child Health Block Grants, private or volunteer organizations serving children with special health care needs, parent advocacy groups, HMOs, business and industry, hospitals and other health care providers and specialty organizations such as the Cystic Fibrosis Foundation. Early Intervention Program directors and nutritionists need to work together to devise suitable payment mechanisms for nutrition services in Early
The Gonzales family:
1. What was Mrs. Gonzales' major nutrition concern about her daughter? She did not want to eat
She had received confusing advice about feeding. 2. How did Mrs. Gonzales attain the services of a nutritionist?
She finally told her El service coordinator that she was concerned because Jennifer wouldn't eat.
3. What did the nutritionist do at the home in terms of screening and assistance? Obtained a diet and feeding history
Observed mealtime
Took anthropometric measurements (e.g. height, weight, head
circumference)
4. How did the nutritionist help with the feeding problems:
Showed Mrs. Gonzales how to add calories to her daughter's diet. Asked Mrs. Gonzales not to force Jennifer to eat.
Helped Mrs. Gonzales overcome behavioral problems around eating.
The Whittle Family:
1. How did Jeanine Whittle feel when Jeffrey starting losing weight? She felt she was failing as a mother.
She felt the weight loss was her fault.
2. Why did feeding issues become such a primary concern for the Whittle family? Because the problems with Jeffrey's feeding were interfering in all aspects of
the family life.
Mealtimes were stressful and unpleasant, causing tension between Mr. and Mrs. Whittle.
The eating problems became a major family issue. 3. How did the nutritionist help the Whittle family?
Provided reassurance that they were doing a good job.
Suggested ways to present foods so Jeffrey would have more control.
Provided support to allow Jeanine to decrease the pressure on Jeffrey to eat. Provided menu ideas and recipes to make every bite count.
4. What benefit did the Whittle family receive from nutrition services?
® A lot of support
o Meal time is pleasant and relaxing; the family can sit and talk
o Eating out is now a pleasure
The Mitchell Family:
1. How long did it take Mrs. Mitchell's service coordinator from the Early Intervention Program to recognize her child's nutrition and feeding concerns?
® six months
2. What helped the El service Coordinator identify the need for nutrition services?
o Feeding issues were getting in the way of obtaining other Early Intervention
goals.
o Gail frequently mentioned how difficult feeding was
o Gail's need to control caloric intake to ensure adequate growth was not being
met by the nutritionist she was seeing.
3. What were the reasons that the nutritionist became involved?
o Mrs. Mitchell became frustrated wanting to ensure adequate nutrition and
optimal growth but not knowing what to do.
o The twins were on pureed foods at 15 months of age.
o Mother had concerns regarding adequacy of caloric intake.
o Mother did not feel the twins would meet their calorie needs if she made the
transition to table foods.
4. How did the nutritionist complete a nutrition assessment?
O Made a home visit
® Analyzed a food diary
® Observed a meal
® Evaluated height, weight, and triceps skinfold measurements
5. What kind of recommendations did the nutritionist provide?
o Suggestions for high calorie finger foods that provided the twins more control
over feeding while increasing caloric intake.
Got them to eat more high calorie foodsresulting in weight gain. Assisted them in oral-motor and self-feeding skills.
7. How could nutrition issues have been identified earlier? Better screening for nutrition problems.
More attention to Gail's concerns.
Better recognition of the cues indicating nutrition and feeding issues. 8. What benefit did the Mitchell family receive from nutrition services?
Played an integral role in developing the family.
Empowered mother to determine her children's nutritional needs and how to
meet them.
Better health for the twins which relieved much of the family stress.
THE MISSING LINK
Post Assessment
Strongly Agree Agree Undecided Disagree Strongly Disagree programs. as a_
can or consultants to EarlyIII
EARLY 1NTERVENTOON NUTRITOO
SC- EEN1NG FORM
To be completed by screener. Refer to protocols for instructions on completing each question. To determine if further assessment is needed, see Nutrition Referral Criteria
DEMOGRAPHICS
1. Screening Date:
2. Child's ID No.: 2
3. Child's Sex : (M) Male (F) Female 3
.0
4. Date of Birth: 4
Fa=1/1
I If5. Birth weight:
6. Birth Length: 6 cm. or
reported by caregiver or found in medical record
7. Gestational age: 7 5 I 1 kgs or ANTHROPOMETRICS 8. Date of measurements: 9. Weight: 10. Length/height:
11. How was the child measured? PERCENTILES 81 I
if
I 1, 91 1Elk9.or
1.1
IEl.m.or
I I I I1= standing, 2 =lying down 1 1
1=1
12. Weight/AGE 12
13. Height/AGE 13
14. Weight/Height 14
LAB WORK
15. Date of Hemoglobin or Hematocrit:
16. HEMOGLOBIN I LJ gms/100m1
18. Date of FEP or Lead (PB): 19. FEP
LI
ug/dI lbs. in11/8
t h lbI oz.inr18th
to I centile 1 I Ito I centile Ito I centile 151 I 1,1 Ior
17. HEMATOCRIT I 181 I 14 I 1/ or 20. LEAD(PB) I21. Does this child have any of the following diagnosis or chronic medical conditions?
21
(Check all that apply)
Down Syndrome Failure to Thrive
_Cardiac
Cerebral Palsy _Fetal Alcohol Syndrome_Kidney
Spina Bifida Cystic Fibrosis _Seizure Disorders
Anemia Neuromuscular _Poor Growth
Respiratory
_Liver
_GastrointestinalOther(specify) percent ug/dI 1-21 Yes OZ.
PEACH Survey
Agency. Date'
Child's Name: Date of Birth'
Address' Phone 4"
Please circle YES or NO for each question as it applies to your child.
Does your child have a health problem (do not include colds or flu)? If yes, what is it?
YES NO
Is your child: Small for age? Too thin' Too heavy/
YES NO
_
(If you check any of the above, please circle YES)
Does your child have feeding problems? If yes, what are they? YES NO
is your child's appetite a problem? If yes, describe: YES NO
Is your child on a special diet? If yes, what type of diet? YES NO
Does your child take medicine for a health problem (Do not include vitamins, iron, or
fluoride)? Name of medicine(s): YES NO
Does your child have food allergies? If yes, to what foods? YES NO Does your child use a feeding tube or other special feeding method? If yes, explain: YES NO Circle YES if your child does not eat any of these foods:
Milk _ Meats Vegetables Fruits (Check all that apply) YES NO
Circle YES if your child has problems with :
Sucking
_
Swallowing Chewing_
Gagging (Check all that apply) YES NO Circle YES if your child has problems with :Loose stools. Hard stoolsThrowing Up Spitting Up (Check all that apply) YES NO Does your child eat clay, paint chips, dirt, or any other things that are not food?
If yes, what? YES NO
Does your child refuse to eat, throw food, or do other things that upset you at mealtime?
If yes, explain: YES NO
Fcr infants under 12 months who are bottle fed:
Does your child drink less than 3 (3-ounce) bottles of milk per day: YES NO For children over 12 months: (Check if applies and circle the YES)
Is your child not using a cup'? Is your child not finger feeding?___ YES NO For children over 18 months:
Does your child still take most liquids from a bottle? YES NO Circle YES if your child is not using a spoon? YES NO Earent Eating and Nutrition Assessment for Qhildren with Special dealth Needs
Cooynght CD 1993 by Marci Camooell and Kristine Kelsey, All Rights Reserved Total =
2 3 3 2 2 2 2
EARLY INTERVENTION NUTRITION SCREENING QUESTIONNAIRE
RI Dept. of Health, Division of Family Health, Earty Childhood Programs
Today's Date:
(Child's Name: Name of Person Completing This Questionnaire:
Child's Birthday and Age:
'Child's Early Intervention ID#: Service Coordinator:
1. Does your child have any food allergies? Yes No Not sure If yes, list foods:
2. Does your child take any medications on a regularbasis? Yes No Not sure If yes, list: (including vitamins, iron, fluoride, or other supplements)
3. Does your child experience any of the following? (Can answer Yes" to more than one)
a. diarrhea Yes No Not sure b. constipation Yes No Not sure c. vomiting/ reflux Yes No Not sure 4. Does your child experience any of the following?
(Can answer "Yes' to more than one)
a. difficulty with sucking Yes No b. difficulty with swallowing Yes No c. difficulty with chewing Yes No d. gagging Yes No e. choking Yes No Not sure Not sure Not sure Not sure Not sure Please circle the choice(s) below that destribe how your child
uses a bottle breastfeeds
takes sips from a cup drinks from a cup uses a straw
eats:
finger feeds led by spoon
self-feeds with spoon self-feeds with fork
uses special feeding equipment
Comments:
Comments:
Comments:
6. If you are currently breastf ceding, do you have any questions or concerns? If yes, describe:
Yes No Not sure
7. If your child uses a bottle:
do you add anything to the bottle? Yes No Not sure if yes, what: does she/he take the bottle to bed? Yes No Not sure
8. Please estimate the amounts (in ounces) that your child usually drinks or is fed in one day (24 hours): oz. formula oz. juice oz. milk breast-milk oz. water name:
Circle choice(s): powder concentrate ready -to -feed tube-feeding (NOTE: If powder or concentrate, please describe how you make it.) type(s):
type(s):
average number and length of feedings:
source: (circle) bottled town well other: oz. punch, koolaid, soda
oz. other GUIDE: 1 measuring cup 8 oz. I smallb:.nle 1 large bottle 8oz. 1 "sippy" cup 4-6 oz. NOTE: Be sure to add up oz. child actually drinks; not what is put in bottle cr
EARLY INTERVENTION NUTRITION SCREENING QUESTIONNAIRE (Continued) PI Dept. of Health. Division at Family Health. Early Childhood Programs
9. Are you concerned about the amount or variety of foods your child takes in from the following food groups? (Can answer "Yes" to more that one)
a. milk and dairy toads Yes No Not sure b. meats, eggs, fish Yes No Not sure c. vegetables Yes No Not sure d. fruits Yes No Not sure e. breads and cereals Yes No Not sure
Comments:
0. Please circle the choice(s) below that describe your meattime experiences and child's eating behaviors: child refuses to eat
child eats well child spits out food
child throws food or utensils child eats too slowly
child eats items which are nct food
(such as crayons, dirt, paper, cigarettes, etc.) child stuffs mouth
child unable to sit through the meal child sits with family for meals child eats separately
mealtimes are pleasant meattimes are hecffc meal seems to take too long no scheduled mealtimes no concerns in this area
Other concerns:
11. Do you often find that you run out of food? Yes No Not sure Comments:
12. Do you have any questions/concerns about your child's nutrition and feeding? Yes No Not sure
If yes, please describe and your service coordinator will discuss them with you:
13. Would you like to receive information and ideas about recommended infant and child foods, eating habits, or next steps?
If yes, your service coordinator will discuss this with you.
14. Would you like to meet with someone about your child's nutrition and/or eating habits?
If yes, your service coordinator will arrange this with you.
Yes No Not sure
EARLY INTERVENTION
NUTRITION SCREENING INFORMATION
1 Date screening begun:
Child's name:
Child's Birthday:
Child's Early Intervention ID#:
Child's gender: (M) Male (F) Female
1. Does this parent or caregiver agree to complete an EARLY INTERVENTION NUTRITION SCREENING QUESTIONNAIRE? Yes No Not sure
Date to be returned:
2. The following information may be important to assess resources for this family:
Does this family obtain AFDC? Yes No Not sure
Does this family obtain food stamps? Yes No Not sure
Coes this family have Medicaid? Yes No Not sure
Is this child enrolled in WIC.program?Yes No Not sure 3. Does this parent or caregiver give consent to send a
release form for weights, lengths or heights, growth chart, and lab work (hematocrtt, hemoglobin, lead) to:
(Check all that apply)
WIC? primary care physician? _specialist?
Information in this block provided by:
parent or caregiver _records from
4. Does this child have any of the following diagnoses or chronic medical conditions? Yes No Not sure (Check all that apply)
Down Syndrome Failure to thrive Cardiac
_Cerebral Palsy _Fetal alcohol
Spina Bifida _Cystic Fibrosis Anemia _Neuromuscular Slow growth _Liver
_Kidney Seizures _Respiratory
Gastrointestinal Other condition affecting nutritional status, growth, or eating ability :
5. Information in this block provided by:
_parent or caregiver _records from
Birth weight: lbs._ oz. or
Birth length:_ in. or
Gestational age: wks.
cm
6. LABWORK
A. Hematocrit: . % or Hemoglobin: ._2/100m1
Date:
(must be within I year) B. Date of last lead screening:
Circle result: normal (<10 ug /dI) abnormal cr :0 ugidl)
If abnormal, last test date:
Result: Lead (P8): .
Source of information: WIC ohysian
Is this parent/caregiver aware of any problems that have been identified with this child's labwork?
Yes No Nct sure If yes or not sure,
(When was it last done?)
7. ANTHROPOMETRICS 17.a. Parent/caregivers report:
Does the parent/caregiver know this child's neight or
length? Yes No ApproXimately Not sure in. as of:
How was child measured? lying standing
Who measured? _WIC ohysician cther
Was a percentile given? `3,/c, No Not sure
Does the parent/caregiver know this child's .A.=ioht?
Yes No Approximately Not sure
Ibloz. as of:
Who weighed? WIC physician
Was a percentile given? % No
7.b. Found in records:
_other
Not sure
What records? _WIC physician czher
Most recent height or length (circle which):
in. or . __cm. Date:
Most recent weight:
_lbs.
oz. or . kg. Date:7.c. Taken by Early Intervention personnel: Date:
Height (child standing): . in. or . cm
Length (child lying): . in. or . crn.
Weight: _lbs._ _oz. or ____. _kg.
jIUTRITION SCREENING RESULTS
tCheck those items that apply then follow appropriate action on the right)
1. ParenVcaregiver agreed to complete questionnaire or
Parent/caregiver declined questionnaire at this time
2. _Family may be eligible forfood/nutrition resources that they do not currently obtain.
_Child participates in the WIC program.
Deot. of Health, Division of Family Health, Early Chiichooc Prcgrarns
GUIDELINE FOR FURTHER ACTION (Circle the actions to be taken)
3. N/A
4. Dx or condition affecting nutritional status, growth, eating ability.
5. _Birth weight < 2500g (5# 8oz.) and/or gestational age < 37 weeks
6. Hematocrit: 34% OR LESS and/or Hemoglobin:11.2 g/dI OR LESS
Lead (Pb): 1 Oug /dl or GREATER
NO LABWORK IN PAST 6 MONTHS
7. Plot growth information on appropriate growth chart for age, gender, and position in which the child was measured (birth to 36 months if lying down: 2 to 18 years if
standing) and attach it to this screening form.
NOTE: If child was low birth weight or premature (see #5 above) and is less than 12 months chronological age, plot CORRECTED AGE as well as chronological age.
Check all that apply for this child below:
_Length or height for age < or = 10th% OR
Length or height for CORRECTED AGE < 10th%
_Weight for length cr height: < or = 25th% if < 12 most
< or =10th% > or = 90th%
Assess risks from questionnaire as below. Offer rescreening in 3 to 6 months. Provide family with referral information.
Obtain release and maintain communication with WIC provider.
REFER for assessment and consultation. Proceed as in #7.
REFER for assessment and consultation. Ask parent/caregiver to request labwork .
REFER for assessment and consultation.
NUTRITION SCREENING QUESTIONNAIRE RESULTS
Check which of the following questions were answered 'Yes"; a "Yes" response indicates a possible risk.)
1 2 3 4 5 6 7 8 9 10 11
2: deck 'yes' if:
5: check 'yes' if:
8: check 'yes" if:
10: check "yes' if:
no source of fluoride
double source of fluoride or iron
megavitamin supplementation
_any frequent or regular medication (including antibiotics, seizure med, etc.)
other:
7 mo. or older and doesn't yet sip from a cup 9 mo. or older and doesn't self feed with fingers
_12 mo. or older and drinks primarily from a bode
19 mo. or older and doesn't yet self-feed with utensils other:
_under 12 mo. and drinks less than 24 oz. formula
12 mo. or older and drinks more than 40 oz. formula or milk
drinks skim or lowfat milk
_drinks more than 12 oz. juice, punCh, koolaid, soda
_uses powdered or concentrated formula and may need guidance in correct preparation
other:
mealtime experiences and child's eating behaviors appear to be of concern
REFER for further assessment or consulta-tion if 2 or more 'Yes-responses to
Resources
1. Niemes L, Dwyer JD. Boston, Ma. Right to Grow: Planning Nutrition Services for Children with Handicaps A Slide Presentation Frances Stern Nutrition Center, New England Medical Center, 1986, 58 slides.
Contact: Johanna Dwyer, D.Sc., RD, Frances Stern Nutrition, New England Medical Center, 750 Washington St. Box 783, Boston, MA. 02111. Phone: 617-636-5273.
2. Bayerl CT, Ries J. EARLY START Nutrition Services In El. Boston MA:
Massachusetts Department of Public Health, 1993. 1 manual, 80 slides.
Contact: Gail Lewis, A.H.E.C. 50 Lake Avenue, Worcester MA. 01604. Phone: 508-756 -6676. Training Manual $35.00; slide set $50.00; make check payable to
A.H.E.C.
This guide contains tools for El providers interested in nutrition training for the families of children birth to three years. The training manual contains program
recommendations, models of nutrition service, nutrition screening and assessment tools, educational materials and reimbursement guidelines. The slide set focuses on common feeding, nutrition, and growth issues for children birth to three years.
3. Cunniff P, Holland M, Goldberg D, Dwyer J, Palmer C, Bayerl C, and Ries J.
Consuming Concerns Videotape and Trainer's Guide. Frances Stern Nutrition Center and Shriver Center University Affiliated Center.
Contact: Frances Stern Nutrition Center, 750 Washington St. NEMC 783, Boston 0211. Phone: 671-636-5273. Price: $25.00. Checks payable to Frances Stern Nutrition Center.
Consuming Concerns is a 21 minute videotape based on the EARLY START slides. The video is designed to enhance the viewer's awareness of the nutrition concerns of children in Birth to Three Early Intervention Programs. The videotape reviews six major nutrition concerns of children in Birth to Three/Early Intervention Programs and the contribution of a nutritionist. The trainer's guide includes a pre and post test, "Fact Sheets" on the nutrition concerns discussed in the video, trigger questions, and an evaluation form.
4. Baer MT, Tanaka TL, and Blyler EM. Nutrition strategies for children with special health care needs: Identifying kids at risk. Los Angeles, CA: Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles,
1991, 150 pp.
27
Contact Irene Palafox, UAP Center for Child Development and Developmental Disorders. Children's Hospital of Los Angeles, Attn: Resource Center Coordinator,
PO Box 547000, Los Angeles, CA 90054 Phone: (213)-669-2300. $35.00 plus $5.00 shipping.
This manual provides guidelines for nutrition screening for children from birth to three years. It includes dietary guidelines for young children and a feeding skills
section that reviews the developmental sequence in the acquisition of skills needed
to consume foods of various textures. A nutrition screening section provides
several screening tools including guides for measuring height and weight and
growth charts for evaluating measurements. The guide contains checklists and/or
fact sheets on various nutrition problems that are frequently experienced by young
children, written in English, Spanish, and/or Chinese. Sections on cerebral palsy,
drug-exposed infants and Down syndrome and their effects on nutrition status and
feeding are also included. It was adapted from the C.H.E.W.S. Nutrition Project,
New Mexico Department of Health and Environment.
5. Batts K, Brizee LS, Carden J, Casey SC, Gonzalez N, Goodwing MA, Hata C, Katsh
N, McLaughlin JF, Peck L, Pederson A, Pipes PL, Stewart KB, Weijohn TT, and Wickberg E. Nutritional guidelines for children with disabilities and chronic
illnesses. Neurodevelopmental Program, Children's Hospital and Medical Center, University of Washington, 1989.
Contact: Materials Management PO Box 47905 Olympia, WA 98504. 206
-586-9046.
This publication is designed to promote nutrition screening, assessment, and
intervention as routine components of comprehensive health care for children with disabilities and chronic illnesses. These guidelines outline appropriate procedures for identification of children who require nutrition assessment and intervention. To those providing nutrition care they provide guidance on comprehensive nutrition
assessment and intervention for many problems common to children with disabilities or chronic illness. These guidelines do not discuss every nutritional concern that a
health care provider may encounter in a child with a disability or chronic illness. Three areas in particular were not included- metabolic disorders, gastrointestinal
anomalies, and medical problems associated with tube feeding.
6. Rokusek C. and Heinrichs E. (eds). Nutrition and feeding for persons with special needs: A practical Guide and Resource Manual. 2nd Edition. Vermillion, SD: University of South Dakota School of Medicine, 1992. 323 pp.
Contact Child and Adult Nutrition Services Division, Department of Education and Cultural Affairs 700 Governors Drove, Pierre, SD 57501-2291. 605-773-3413.
of the Americans with Disabilities Act and civil rights regulations. Topics covered include nutrition challenges of persons with special needs; the role of school foods service; partnerships in meeting special nutrition and feeding needs; vitamins, minerals, and fluids; nutrition screening and assessment; identifying children at risk; nutritional care of slow growing and underweight children; management of the overweight individual; diets for selected medical and genetic conditions; tube feeding; bowel problems; food allergies and hyperactivity; management of unusual eating patterns and failure to thrive; gagging, vomiting, and rumination; feeding assessment and intervention; drug, nutrient, and food interactions; oral and dental considerations; and behavior issues in nutrition and feeding programs.
7. Carp D, Krick J, and Webster C. Eating for good health: a nutrition handbook for caretakers of the handicapped children, The Nutrition Division.
Contact Jackie Krick, the Nutrition Division, The John F. Kennedy Institute for Handicapped Children, 707 North Broadway, Room 20, Baltimore MD. 21205 Phone: 410-522-5441.
This packet provides information that ties together the relationship of nutrition factors and clinical strategies to disabilities. Topics are covered by both a scientific based description for professionals and nutrition education fact sheets for families and parents, and include: feeding, dental health, fluids, diet and underweight, diet and weight control, dietary fiber, and constipation, lead poisoning , megavitamin therapy nutritional effects of drug therapy, and hyperactivity.
8. Shaddix T and Barncastle N. Nutritional care for the child with developmental disabilities. Birmingham AL. United Cerebral Palsy of Alabama, 1986.
Contact Tina Shaddix, United Cerebral Palsy, 2430 11th Avenue North, Birmingham AL. 35234. Phone: (205) 251-0165.
This five pamphlet series provides relevant information on nutrition to those
involved in the care and treatment of children with developmental disabilities. Each pamphlet addresses a major nutritional concern of the child with developmental disabilities and offers dietary measures designed to alleviate the problem. The titles of the pamphlet are: Promoting weight gain, Weight control for the overweight child, Oral motor development and feeding techniques, Management of
constipation, and Meal planning for the childhood years.
9. University of Alabama at Birmingham, Sparks center for Developmental and
Learning Disorders. Nutrition for children with special health care needs. Birmingham AL Sparks Center for Developmental and Learning Disorders, University of Alabama at Birmingham, 10 brochures. (Family education series).
Contact: Sparks Center for Developmental and Learning Disorders, University of Alabama at Birmingham, Box 13, University Station, Birmingham Al 35294. Phone: 205-934-1104.
This set of brochures is designed to help parents of children with special health care needs promote their child's nutrition and good eating habits. A general brochure on nutritional goals, discussing growth, good feeding skills, disease
resistance, energy, and normal elimination contains 9 subject specific brochures on: chewing, positioning for eating, weight gain, self-feeding, swallowing relieving constipation, fluid needs, drinking from a cup, and preventing iron deficiency
anemia.
10. Nutrition Focus for Children with Special Health Care Needs. Nutrition Section Children Development and Mental Retardation Center, University of Washington. Contact Sharon Feucht, Editor Nutrition Focus, CDMRC, University of Washington Box 37920 Seattle WA 98105-7920 Phone: 206-685-1297. Cost: $24.00 per year. This bimonthly newsletter features nutrition issues of children with special health care needs and their families. The newsletter is designed for use by health care providers and others who serve these children in a community or ambulatory setting. Each feature article highlights a specific disorder or nutrition concern and offers practical suggestions through nutrition assessment and intervention
strategies, case studies, and references and resources for clients, families, and the health care professional.
11. Van Riper CL, and Beeman LE. Pediatric nutrition screening and assessment: A self study module. Omaha NE. Meyer Rehabilitation Institute. University of Nebraska Medical Center, 600 South 42nd St. Omaha NE. 68198. Phone: (402) 559-7467.
U.S. DEPARTMENT OF EDUCATION
Office of Educational Research and Improvement (OERI) Educational Resources information Center (ERIC)
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